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About Vasectomy

THE OPERATION

The vas is the medical name for the tube along which sperm travel from the testes to the penis. With vasectomy this tube is blocked on each side. This interruption in the supply of sperm prevents the sperm from joining the rest of the seminal fluid, which is mainly produced by the prostate gland further along the tube.

HOW IS IT DONE?

A number of different techniques can be used to achieve this interruption. A new method recently developed involves sealing the tube to the outside, and enclosing the other end that comes up from the testicle in an envelope of body tissue. This does not block the tube and avoids the congestion which was thought to lead to occasional post-op pain. This is the method currently in use by us.

Does it hurt?

There is a minimal amount of discomfort, for a matter of seconds, while the anaesthetic is injected into the skin of the scrotum and around the vas. It feels similar to having local anaesthetic prior to having a tooth filling and it does not go near the testes.

The effects

The operation does not affect the ability of the man to perform sexual intercourse and does not affect sexual drive in any way. Seminal fluid will continue to be ejaculated when a man reaches a climax but it will not contain sperm. The testicles continue to produce the hormone which is responsible for masculine qualities. In other words, the operation does not affect a man’s sexuality.

Does it work straight away?

No. Because sperm remain in the tubes for some time you always have to continue using contraception until 2 sperm counts are checked and reported ‘all clear’. These are sent by post 3 months after the operation, and we write to you with the results.

After the operation

1. Some minimal bruising and discomfort may be expected during the first 1-3 days but this usually resolves without treatment (similar to tooth filling or extraction). Some patients may wish to take something for this pain, such as paracetamol or Nurofen.

2. After the operation, the remainder of the day should be spent resting. Office type work can be done next day. It is important to avoid heavy lifting, heavy physical work, vigorous exercise and active sport for at least one week after the operation. Depending on your occupation, it may be necessary to take up to one week off work. This is not a reflection on the severity of the operation, rather that the scrotum is very mobile and subject to friction and needs rest to allow all the tissues and blood vessels to seal and heal.

REST IS IMPORTANT. IF THIS ADVICE IS IGNORED COMPLICATIONS SUCH AS BLEEDING, INFECTION, PAIN AND SWELLING ARE COMMON.

3. Most sports activity can be resumed whenever you feel able to participate. Swimming, walking, golf and cycling can usually be resumed after 3-5 days. Running, or running related sports such as tennis take about 10 days. Any contact sport, especially football, has to be avoided for 3 weeks.

4. It is essential that the couple use other forms of contraception following the vasectomy operation until the man has had two samples of semen examined to make sure that there are no sperm present. It is advised to have a minimum of 20 ejaculations before sending the sample to the laboratory after the operation.

5. In a small number of cases these will not be fully clear and the test will have to be repeated. Very occasionally, the semen may be very slow to clear and sperm can be present more than a year after the operation.

Who should not have a vasectomy?

If either you or your partner is not 100% certain that your family is complete, you should consider a different contraceptive method.
– If either of you has an ongoing sexual problem, vasectomy will not help that in any way, and probably should be avoided until the problem is addressed.
– If you have a history of recurring epididymitis, or of recurring testicular pain.
– If you have any testicular lump that has not been checked by a doctor. A varicocoele is not a contraindication.
– If you are on Warfarin, it may be a problem. This can be discussed with the doctor.
– If you are less than 30 years of age, there would need to be compelling reasons for having a vasectomy as a later successful reversal cannot be guaranteed.

Can a vasectomy fail?

While vasectomy must be considered as permanent in terms of fertility, there is a very small failure rate when the two ends of the tube grow together again. This happens in about 1 in 1000 cases in the first four months and will be picked up on sperm testing. Even with multiple clear sperm counts, a failure is still possible. It is believed to happen to 1 in 3000 vasectomies.

Possible Complications

Though Vasectomy is regarded as a relatively minor surgical procedure, occasional complications may arise (as with any operation).

1. Wound infections may occur or the wound may be slow to heal. Both of these need to be re-checked, ideally by the doctor who did the procedure, in case they require treatment.

2. Scrotal Haematoma occurs in about 1% of cases. It is caused by some bleeding into the tissues around the testicle and may give rise to pain and swelling. This is commonest during the first 2-3 days, is likely to occur if stipulation regarding rest is not observed and can be troublesome. If any swelling occurs, it is essential that it be checked by the doctor who did the operation. Significant haematomas, in our experience, occur in less than 0.1% of vasectomies.

3. Epididymitis is a condition in which the epididymis- where sperm go immediately after they leave the testicle – becomes inflamed. This can occur following a vasectomy, but it can also occur in men who have not had a vasectomy. It is less common after open ended vasectomy (as described above) and usually responds well to treatment with an anti inflammatory drug. If a man has suffered from recurring epididymitis, he should probably avoid vasectomy.

4. Sperm Granuloma may occur in up to 5% of vasectomy cases. These are small lumps which form at the end of the vas, particularly on the side still carrying sperm. These are harmless and usually do not cause any problems but if they become tender or painful it may be necessary to remove them surgically. This procedure can be done under local anaesthetic, but it is extremely rare.

5. Vary rarely men suffer from persistent pain in the testicle or at the vasectomy site which does not have an obvious cause. Treatment of this condition is difficult, as the reason for the pain is unknown, and most men suffering from this will be referred to a specialised urologist.. It is hoped that the new open ended technique as outlined above will be proven in time to significantly reduce the occurrence of this pain.

6. Sexual problems arising after a vasectomy operation should not necessarily be blamed on the vasectomy. Most problems are due to circumstances or factors that are present before the vasectomy which makes it important that any problem of this nature is identified and addressed before the vasectomy.